Current management: Management of rheumatic diseases in the era of biological anti-rheumatic drugs

Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
Acta Orthopaedica (Impact Factor: 2.77). 11/2005; 76(5):614-9. DOI: 10.1080/17453670510041673
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Available from: Matti Lehto, Aug 13, 2014
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    • "Patients with RA have a higher risk of deep infection ( Schrama et al. 2010). Biological anti-rheumatic drugs in particular may predispose to wound infections (Konttinen et al. 2005). Other inflammatory arthritides do not appear to be associated with increased infection risk after primary knee replacement (Jämsen et al. 2009a). "
    Acta Orthopaedica 12/2010; 81(6):660-6. DOI:10.3109/17453674.2010.537805 · 2.77 Impact Factor
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    • "has been advocated. The introduction of anti-TNF drugs has also brought about far-reaching changes to the medical treatment of RA (Konttinen et al. 2005). One-third of our patients were on biological treatment, the same level as reported recently in the Netherlands (Boonen et al. 2006). "
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    ABSTRACT: Our knowledge of frequency of foot involvement in rheumatoid arthritis (RA) is still often based on a study from Finland in 1956. Great changes in the treatment of RA may have led to a different situation. We investigated the distribution of joint involvement in RA patients today, with special attention given to the feet and subjective walking ability. 1,000 RA patients answered a questionnaire concerning joints affected, joint surgery, foot problems, and subjectively experienced reasons for walking incapacity. In 45% of the patients, the forefoot was involved at the start of the disease. In 17%, the hindfoot/ankle was involved at the start. Only hand symptoms were commoner. 80% of patients reported current foot problems, 86% in the forefoot and 52% in the hindfoot/ankle. Difficulty in walking due to the feet was reported by 71%. For 41% of patients, the foot was the most important part of the lower extremity causing reduced walking capacity, and for 32% it was the only part. After the hand, the foot was the most frequently symptomatic joint complex at the start of the disease, but also during active medical treatment. The foot caused walking disability in three-quarters of the cases and-4 times as often as the knee or the hip-it was the only joint to subjectively impair gait.
    Acta Orthopaedica 05/2008; 79(2):257-61. DOI:10.1080/17453670710015067 · 2.77 Impact Factor
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    • "Short term i.v. pulses of MP are useful as bridge therapy in patients refractory to other therapies (Laan et al 1999) and play a role in combination therapy with newer biological DMARDs with slow onset of activity (Konttinen et al 2005). Intravenous doses of methylprednisolone , however, have high rate of clearance. "
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    ABSTRACT: A glycinate derivative of alpha-methylprednisolone (MP) was prepared and conjugated to a linear cyclodextrin polymer (CDP) with a loading of 12.4% w/w. The polymer conjugate (CDP-MP) self-assembled into nanoparticles with a size of 27 nm. Release kinetics of MP from the polymer conjugate showed a half-life (t1/2) of 50 h in phosphate buffer solution (PBS) and 19 h in human plasma. In vitro, the proliferation of human lymphocytes was suppressed to a similar extent but with a delayed effect when CDP-MP was compared with free MP. In vivo, CDP-MP was administered intravenously to mice with collagen-induced arthritis and compared with free MP. CDP-MP was administered weekly for six weeks (0.07, 0.7, and 7 mg/kg/week) and MP was administered daily for six weeks (0.01, 0.1, and 1 mg/kg/day). Body weight changes were minimal in all animals. After 28 days, a significant decrease in arthritis score was observed in animals treated weekly with an intermediate or high dose of CDP-MP. Additionally, dorsoplantar swelling was reduced to baseline in animals treated with CDP-MP at the intermediate and high dose level. Histological evaluation showed a reduction in synovitis, pannus formation and disruption of architecture at the highest dose level of CDP-MP. MP administered daily at equivalent cumulative doses showed minimal efficacy in this model. This study demonstrates that conjugation of MP to a cyclodextrin-polymer may improve its efficacy, leading to lower doses and less frequent administration for a safer and more convenient management of rheumatoid arthritis.
    International Journal of Nanomedicine 02/2008; 3(3):359-71. DOI:10.2147/IJN.S3217 · 4.38 Impact Factor
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